ASSOCIATION OF DIRECTORS OF PUBLIC HEALTH (ADPH) – WRITTEN EVIDENCE (PSR0069)

 

House of Lords Public Services Committee Inquiry – Lessons from Coronavirus

 

On 17th June, the President of the Association of Directors Public Health (ADPH) Dr Jeanelle de Gruchy was invited to give oral evidence to the House of Lords Public Services Committee. This written submission is intended to complement and reinforce the messages ADPH presented during the oral evidence session.

Introduction

 

The ADPH has taken a clear view about our approach to COVID-19 and engaging with the Government: to be as constructive as possible and as challenging as necessary. There are immense challenges and strong collaboration is a key part of saving lives. Our early thoughts about the response to COVID-19 are very much made in the spirit of improving what we can do now and putting in place what will be needed in the weeks and months ahead. Those must be the priorities for all.

 

In time we will need to consider what has worked well and what has not – and strengthen the system for the future. We must ensure that we are better prepared for future pandemics, this includes reflecting on current structures, roles and responsibilities, as well as ensuring that each part of the system is adequately funded and resourced. Any review of the Public Health system’s response and readiness for future pandemics needs to be scoped and conducted as a whole system with both national and local partners. The need for neutrality in designing our future Public Health system is vital. 

 

There are also broader questions to consider about the government’s approach to health and prevention. The health inequalities that exist in the UK have once again been starkly exposed and amplified. The government must start by setting out a comprehensive response to the Prevention Green Paper consultation. As a society we still tend to think that a healthy population is created by the NHS – this is not the case.

 

However, these are much longer-term conversations; we need to recognise that we are still in the early stages of this pandemic. There is more immediate learning that we must reflect on now, as we move into the next phase of the pandemic.

 

In recent weeks, there has been increasing recognition about the value of local public health leadership as a vital component of an effective response to COVID-19. Directors of Public Health (DsPH) are continuing to build closer working relationships with the Chief Medical Officer (CMO) and Deputy Chief Medical Officer (DCMO), Public Health England (PHE) and other local partners. The whole public health system has been strengthened over the course of the pandemic and has risen to the sheer scale of this challenge. 

 

  1. What failures has the outbreak exposed in central and local government cooperation on public service delivery, and how could public service reform address such issues?

 

1.1.       Communication

 

1.2.       Disconnect between national and local government

 

1.3.       Poor recognition of the role of DsPH and the local public health system

 

1.4.       Lack of investment in public health and prevention

 

  1. Did funding issues limit the ability of local services to respond to the crisis and, if so, which services proved the least resilient?

 

 

  1. How effectively have different local and national services been able to share data during the outbreak, and what obstacles to data-sharing now need to be addressed?

 

 

  1. Has coronavirus exposed weaknesses in the relationship between NHS England and councils, and Public Health England and local directors of public health? If so, how can these weaknesses be addressed?

 

The effective delivery of local health protection services requires close partnership working between PHE, the NHS and local government, amongst others. The whole public health system has been strengthened over the course of the pandemic and is rising to the sheer scale of this challenge.

While there are some more immediate issues that can be addressed, a longer-term conversation is needed to reflect on the lessons learned and explore how these relationships can be strengthened going forward.

4.1.       Relationship with NHSE

 

4.2.       Relationships with PHE

 

4.3.       Strengthening our Health Protection system

ADPH and PHE recently published a guide on What Good Looks like for High Quality Local Health Protection Systems. However, a longer-term conversation is needed to reflect on the lessons learned during this pandemic and explore how we can strengthen the public health system as a whole. This includes the following:

 

 

Any review of the Public Health system’s response and readiness for future pandemics needs to be scoped and conducted as a whole system with both national and local partners. The need for neutrality in designing our future Public Health system is vital. 

 

Association of Directors of Public Health

June 2020

ADPH | Registered Charity Number 1164513                             June 2020
enquiries@adph.org.uk | Tel: 020 7832 6944 | www.adph.org.uk                


[1] The Health Foundation, Public Perceptions of Health and Social Care in Light of COVID-19 (2020)

[2] The King’s Fund, Public health: our position (2019)

[3] McGinnis, J.M., Williams-Russo, P., Knickman, J.R. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002; 21(2): 78-93.

[4] Association of Directors of Public Health, ADPH Policy Survey 2019 Report (2019)